A ruptured ovarian cystadenofibroma presenting with life-threatening sepsis and an incidental synchronous endometrial stromal sarcoma

A woman in her 60s presented with a rare complication of an ovarian cyst which many clinicians may not consider at first presentation. She was admitted with life-threatening staphylococcus aureus sepsis. She presented shocked with a collapse following a 2-day history of diarrhoea, vomiting and pain in the right iliac fossa. She was taken to theatre where a ruptured, widely infarcted left ovarian serous cystadenofibroma was discovered with over 2 litres of purulent fluid exuding from the cyst into the abdomen. She had a left cyst removal, hysterectomy and bilateral salpingo-oophorectomy performed. Histological analysis and molecular gene testing of an incidentally discovered uterine neoplasm revealed an undifferentiated uterine sarcoma. She successfully recovered as an inpatient and was discharged under the care of an oncology team for ongoing management.

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Pneumothorax presentation in endometrial sarcoma patients receiving chemotherapy: A case series

Rare Tumors ◽

10.1177/2036361320972865 ◽

2020 ◽

Vol 12 ◽

pp. 203636132097286 ◽

Cited By ~ 1

Author(s):

Angela Duvalyan ◽

Kirk Tran ◽

Christopher Lee ◽

Shefali Chopra ◽

James Hu

Keyword(s):

Hormone Therapy ◽

Case Reports ◽

Rare Complication ◽

Case Series ◽

Endometrial Stromal Sarcoma ◽

Uterine Sarcoma ◽

Low Grade ◽

Stromal Sarcoma ◽

Endometrial Sarcoma ◽

Undifferentiated Uterine Sarcoma

Endometrial stromal sarcomas (ESS) account for 10-15% of uterine malignancies and are classified into four categories: endometrial stromal nodule (ESN), low-grade endometrial stromal sarcoma (LG-ESS), high-grade endometrial stromal sarcoma (HG-ESS) and undifferentiated uterine sarcoma (USS). Depending on stage, ESS is treated with surgery, hormone therapy, chemotherapy or targeted therapy. A rare complication of ESS with metastatic pulmonary disease is recurrent, bilateral pneumothoraces. The current literature has reported on patients with ESS who either presented with pneumothoraces at their initial diagnosis, and thus were untreated, or after treatment with surgical resection and hormone therapy. There have been no case reports of patients with ESS who presented with pneumothoraces while receiving chemotherapy. Furthermore, there have been no reported cases of patients with HG-ESS presenting with this rare complication. We would like to expand the literature by reporting on two patients with HG-ESS who presented with pneumothoraces while concurrently receiving chemotherapy.

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A Pelvic Pseudotumor in a Nonhemophilic Patient: An Unusual Presentation

Case Reports in Hematology ◽

10.1155/2015/359735 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

Mohamad Gouse ◽

Abel Livingston ◽

Dan Barnabas ◽

Vinoo Mathew Cherian

Keyword(s):

Complete Blood Count ◽

Rare Complication ◽

Iliac Fossa ◽

Plain Radiograph ◽

Factor Ix ◽

Lytic Lesion ◽

Excision Biopsy ◽

History Of ◽

Factor Ix Deficiency ◽

The Right

Hemophilic pseudotumor is a rare complication of hemophilia, occurring in 1 to 2 percent of individuals with severe factor VIII or factor IX deficiency. A 35-year-old male presented with a swelling in the right lower abdomen for 3 months. There was no history of trauma. Examination revealed a swelling over the right iliac fossa. Right hip showed 30° flexion deformity. Blood investigations like complete blood count, APTT, PT, bleeding and clotting time, and fibrinogen were all normal. Plain radiograph and MRI showed a lytic lesion in the right iliac wing. Excision biopsy of the swelling showed organized hematoma with a fibrous capsule suggestive of a pseudotumor. Further haematological workup like factors VIII and IX was normal. At 2 years follow-up, there was no recurrence. We report this case of pseudotumour in patient without any bleeding disorder. Such case has not been reported in literature to the best of our knowledge.

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Hepatic brucelloma: a rare complication of a common zoonotic disease

BMJ Case Reports ◽

10.1136/bcr-2020-237076 ◽

2020 ◽

Vol 13 (12) ◽

pp. e237076

Author(s):

George Vatidis ◽

Eirini I Rigopoulou ◽

Konstantinos Tepetes ◽

George N Dalekos

Keyword(s):

Rare Complication ◽

Surgical Excision ◽

Coombs Test ◽

Inflammation Markers ◽

Laboratory Findings ◽

Ct Guided ◽

Rare Manifestation ◽

Bone Marrow Cultures ◽

History Of ◽

The Right

Hepatic brucelloma (HB), a rare manifestation of brucellosis, refers to liver involvement in the form of abscess. A 35-year-old woman stockbreeder was admitted due to 1-month history of evening fever, sweating and weight loss, while she was on 3-week course of rifampicin/doxycycline for suspected brucellosis. On admission, she had hepatosplenomegaly and a systolic murmur, while cholestasis, increased inflammation markers and a strong-positive Wright-Coombs test were the main laboratory findings. As blood and bone marrow cultures were unrevealing, further investigation with CT imaging showed a central liver calcification surrounded by heterogeneous hypodense area being compatible with HB. Material from CT-guided drainage tested negative for Brucella spp. After failure to improve on a 10-week triple regiment, surgical excision was decided and Brucella spp were identified by PCR. Our case highlights challenges in establishing HB diagnosis, which should be considered on the right epidemiological context and when serological and radiological evidence favour its diagnosis.

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Intraorbital Abscess: A Rare Cause of Orbit Compression

FACE ◽

10.1177/27325016211005062 ◽

2021 ◽

pp. 273250162110050

Author(s):

Samuel Ruiz ◽

Rizal Lim

Keyword(s):

Pediatric Population ◽

Rare Complication ◽

Disease Process ◽

Rare Condition ◽

External Drainage ◽

Direct Extension ◽

Life Threatening ◽

History Of ◽

High Index Of Suspicion ◽

Prompt Diagnosis

Introduction: Intraorbital abscess is a rare complication of rhinosinusitis that affects most commonly the pediatric population. It is thought to be caused by direct extension or venous spread of infections from contiguous sites and can lead to life-threatening complications, like permanent visual loss and cerebral abscesses. Objectives: Intraorbital abscess is a rare condition that requires prompt diagnosis and treatment to avoid serious complications. Our objectives are to provide an overview of this rare disease process and its management including our successful treatment experience. Case Description: We present a 2 case report of a 13-year-old pediatric male and a 66-year-old male with history of chronic sinusitis who presented with a right intraorbital abscess successfully treated with external drainage with decompression of the orbit. Conclusion: When intraorbital abscess is encountered, a high index of suspicion is needed to allow prompt and accurate diagnosis for this infrequent condition. Timely surgical drainage of the abscess is needed to prevent the development of fatal complications.

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Exclusive Phlebosclerosis of Submucosal Veins Leading to Ischemic Necrosis and Perforation of the Large Bowel: First European Case

Case Reports in Gastroenterology ◽

10.1159/000488195 ◽

2018 ◽

Vol 12 (1) ◽

pp. 137-142 ◽

Cited By ~ 1

Author(s):

Sebastian Klein ◽

Denise Buchner ◽

De-hua Chang ◽

Reinhard Büttner ◽

Uta Drebber ◽

...

Keyword(s):

Wall Thickening ◽

Caucasian Woman ◽

Ischemic Necrosis ◽

Colonic Wall ◽

Asian Patients ◽

Life Threatening ◽

History Of ◽

Mesenteric Vessels ◽

The Right ◽

European Woman

Phlebosclerotic colitis (PC) is a rare, potentially life-threatening disease of unclear pathogenesis almost exclusively reported in Asian patients of both genders. A fibrous degeneration of venous walls leads to threadlike calcifications along mesenteric vessels and colonic wall thickening, detectable by CT. This causes disturbed blood drainage and hemorrhagic infarction of the right-sided colonic wall. This is a report of PC in a Caucasian woman in Europe without Asian background and no history of herbal medications, a suspected cause in Asian patients. CT revealed no calcification of the mesenteric vein or its tributaries. Instead, submucosal veins of the left-sided colonic wall were calcified, leading to subsequent transmural necrosis. Clinically, the patient developed a paralytic ileus and sigmoidal perforation during a 2-week hospitalization due to a bleeding cerebral vascular aneurysm. This case of a European woman with PC is unique in its course as well as its radiologic, clinical, and pathologic presentation.

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Amyand's hernia and acute appendicitis: Case presentation in Basic Hospital of Chone

International Journal of Health Sciences ◽

10.29332/ijhs.v4n2.440 ◽

2020 ◽

Vol 4 (2) ◽

pp. 19-23

Author(s):

Orelvis Rodríguez Palmero ◽

Liseidy Ordaz Marin ◽

María Del Rosario Herrera Velázquez ◽

Agustín Marcos García Andrade

Keyword(s):

Abdominal Pain ◽

Inguinal Hernia ◽

Acute Appendicitis ◽

Physical Examination ◽

Iliac Fossa ◽

Amyand’S Hernia ◽

Case Presentation ◽

The North ◽

History Of ◽

The Right

Present the case of a 66-year-old male patient, with a history of right inguinal hernia, who was referred to the emergency room at the IESS de Chone Basic Hospital in the north of the Manabí province, Ecuador, with symptoms of Abdominal pain of more than 24 hours of evolution located in the right iliac fossa and inguinal region on the same side, in the physical examination the hernia was impossible to reduce, so he was taken to the operating room, in the intervention the cecal appendix was found swollen within the hernial sac, a condition known as Amyand's hernia.

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Torsion of a parasitic leiomyoma: a rare but important differential in women presenting with lower abdominal pain

BMJ Case Reports ◽

10.1136/bcr-2019-232797 ◽

2021 ◽

Vol 14 (1) ◽

pp. e232797

Author(s):

Clemmie Stebbings ◽

Ahmed Latif ◽

Janakan Gnananandan

Keyword(s):

Abdominal Pain ◽

Iliac Fossa ◽

Lower Abdominal Pain ◽

Sudden Onset ◽

Greater Omentum ◽

Caribbean Woman ◽

History Of ◽

Right Iliac Fossa Pain ◽

The Right ◽

Fat Stranding

A 39-year-old multiparous Afro-Caribbean woman attended the emergency department with sudden-onset severe right iliac fossa pain. Her inflammatory markers were mildly elevated. Computerised tomography of the abdomen demonstrated features of fat stranding in the right iliac fossa suspicious of acute appendicitis. The scan also noted uterine leiomyomas. The patient was taken to theatre for an emergency diagnostic laparoscopy where her appendix was found to be macroscopically normal. A necrotic heavily calcified parasitic leiomyoma was seen in the right adnexa, free of the uterus and adherent to the greater omentum on a long torted pedicle. The parasitic leiomyoma was successfully removed piecemeal laparoscopically. Complications of leiomyomas, namely, torsion and necrosis, are important differentials in women presenting with sudden-onset lower abdominal pain. A history of sudden-onset severe lower abdominal pain with a background of known leiomyoma should prompt the clerking surgeon to consider a complication of leiomyoma as part of the differential diagnoses.

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Giant Intrahepatic Subcapsular Haematoma: A Rare Complication following Laparoscopic Cholecystectomy—A Case Report and Literature Review

Case Reports in Surgery ◽

10.1155/2020/6410790 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Eltaib Saad ◽

Lauren O’Connell ◽

Anne M. Browne ◽

W. Khan ◽

R. Waldron ◽

...

Keyword(s):

Rare Complication ◽

Rare Event ◽

Decisive Role ◽

Postoperative Monitoring ◽

Refractory Hypotension ◽

Life Threatening ◽

The Right ◽

Tomography Scan

We report on a 59-year-old female with symptomatic cholelithiasis on a background of morbid obesity who underwent an elective LC with an uncomplicated intraoperative course; however, she experienced a refractory hypotension within one hour postoperatively with an acute haemoglobin drop requiring fluid resuscitation and blood transfusion. A triphasic computed tomography scan revealed a large intrahepatic subcapsular haematoma (ISH) measuring 21 cm × 3.1 cm × 17 cm surrounding the lateral surface of the right hepatic lobe without active bleeding. She was managed conservatively with serial monitoring of haemoglobin and haematoma size. A follow-up ultrasound scan after eight weeks confirmed complete resolution of the haematoma. Giant ISH is a fairly rare, but life-threatening complication following LC which merits special attention. This case demonstrates the necessity of close postoperative monitoring of patients undergoing LC and considering the possibility of ISH, although being rare event, in those who experience a refractory postoperative hypotension. It also highlights the decisive role of diagnostic imaging in securing a timely and accurate diagnosis of post LC-ISH.

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JAZF1–SUZ12 endometrial stromal sarcoma forming subserosal masses with extraordinary uptake of fluorodeoxyglucose on positron emission tomography: a case report

Diagnostic Pathology ◽

10.1186/s13000-019-0897-y ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

Koto Fujiishi ◽

Shigenori Nagata ◽

Rieko Kano ◽

Chiaki Kubo ◽

Maasa Shirayanagi ◽

...

Keyword(s):

Positron Emission Tomography ◽

Endometrial Stromal Sarcoma ◽

Emission Tomography ◽

Low Grade ◽

Neoplastic Cells ◽

Pelvic Magnetic Resonance Imaging ◽

Stromal Sarcoma ◽

Positron Emission ◽

Mesenchymal Neoplasm ◽

The Right

Abstract Background Low-grade endometrial stromal sarcoma (ESS) is rare mesenchymal neoplasm, recently specified as harboring JAZF1–SUZ12 rearrangement. Typical JAZF1–SUZ12 ESS is slow growing, in which high uptake of fluorodeoxyglucose (FDG) on positron emission tomography (PET) and subserosal masses are quite unusual. Case presentation A 69-year-old Japanese woman complained of urinary incontinence. Pelvic magnetic resonance imaging showed uterine lesions composed of (1) a 9 × 8 × 7-cm mass protruding from the right-anterior wall, (2) a 4.5-cm mass attached to the right-posterior wall, and (3) a 6.5-cm intramural mass in the fundus. FDG-PET demonstrated maximum standardized uptake value of 13.28 confined to the two subserosal masses (1 & 2) in contrast to no uptake of the intramural mass (3). She was diagnosed with a high-grade uterine sarcoma concomitant with leiomyomas and underwent total hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. The removed uterus had three tumors—two in the right-anterior and right-posterior subserosa, respectively, and the remaining in the fundal myometrium. Microscopically, the three tumors shared morphologic features characterized by neoplastic cells similar to proliferative-phase endometrial stromal cells, in which neither round-cell component, pleomorphism, nor high mitotic activity was recognized. Nuclear cyclin D1 immunostaining was identified 50% of neoplastic cells in the two subserosal tumors (1 &2) whereas < 1% positive cells in the intramural component (3). Reverse transcriptase-polymerase chain reaction showed the same-sized electrophoretic bands indicating JAZF1–SUZ12 gene fusion shared by the three uterine tumors and a focal tumor extension into the extrauterine vein. The patient is alive without evidence of recurrence at 14 months after surgery. Conclusions Pathologists and clinicians should not exclude the possibility of JAZF1–SUZ12 ESS even when uterine subserosal masses demonstrate extraordinary FDG uptake on PET. Molecular analysis is helpful for diagnostic confirmation of JAZF1–SUZ12 ESS with a complex growth pattern.

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A Clinical and Pathologic Study of 34 Sarcomas of the Uterus

Tumori Journal ◽

10.1177/030089168106700411 ◽

1981 ◽

Vol 67 (4) ◽

pp. 341-348 ◽

Cited By ~ 3

Author(s):

Rado Kenda ◽

Giuseppe De Palo ◽

Salvatore Andreola ◽

Gaetano Bandieramonte ◽

Giovanni Lupi ◽

...

Keyword(s):

Clinical Trials ◽

Endometrial Stromal Sarcoma ◽

Controlled Clinical Trials ◽

Relapse Free Survival ◽

Histologic Subtype ◽

Uterine Sarcomas ◽

Free Survival ◽

Stromal Sarcoma ◽

Pathologic Features ◽

History Of

The clinical and pathologic features of 34 uterine sarcomas were studied to determine the natural history of the disease. Sixteen patients had leiomyosarcoma, five mixed mesodermal sarcoma, ten endometrial stromal sarcoma, two carcinosarcoma and one endolymphatic stromal myosis. The patients were treated without an unique protocol. At 3 years the actuarial relapse-free survival was 53.6 %: 68.4 % in stage I-II patients and 22.2 % in stage III-IV patients. As regards the histologic subtype mixed mesodermal sarcomas had the best prognosis; endometrial stromal sarcomas the worst. The necessity of a uniform clinical and histologic classification as well as the importance of controlled clinical trials are pointed out.

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